LASIK术后再次手术时应用飞秒激光再制瓣与用原瓣的比较研究

目的　探讨ＬＡＳＩＫ术后再次手术时应用飞秒激光制瓣的可行性及其临床疗效。方法　选择在我院行近视ＬＡＳＩＫ矫治后再次出现近视并要求手术的患者４３例（８６眼），根据手术方法不同分为观察组（２５例５０眼）和对照组（１８例３６眼）。观察组用飞秒激光制瓣，在波前像差引导下行准分子激光切削，对照组掀开原角膜瓣后也同样在波前像差引导下行准分子激光切削。比较术后６个月的裸眼视力、屈光度、高阶像差、对比敏感度等。结果　术后观察组患者角膜反应轻，对照组大部分患者有不同程度的刺激症状，角膜上皮内生发生率较高。术后６个月，观察组的裸眼视力（１．０５±０．０１）高于对照组（０．９２±０．２１），差异有统计学意义（Ｐ＜０．０５）；观察组的等效球镜度数为（０．５３±０．３４）Ｄ，对照组为（－０．２３±０．４７）Ｄ，差异有统计学意义（Ｐ＜０．０１）；观察组总高阶像差、彗差和球差均较术前明显降低，差异均有统计学意义（均为Ｐ＜０．０５）；对照组总高阶像差、彗差和球差均较术前增加，差异均有统计学意义（均为Ｐ＜０．０５），两组间像差比较，除三叶草差异无统计学意义外，其余均显示观察组明显低于对照组，差异均有统计学意义（均为Ｐ＜０．０５）。观察组对比敏感度在１．５ｃ·ｄ－１、３．０ｃ·ｄ－１、６．０ｃ·ｄ－１、１２．０ｃ·ｄ－１、１８．０ｃ·ｄ－１空间频率下较术前均有改善，差异均有统计学意义（均为Ｐ＜０．０５），对照组除在６．０ｃ·ｄ－１空间频率下与术前相比差异无统计学意义外，在其余空间频率下均较术前下降，差异均有统计学意义（均为Ｐ＜０．０５），观察组在５个空间频率下均显著高于对照组（均为Ｐ＜０．０５）。观察组患者满意率为９２．０％，高于对照组的７７．８％ （Ｐ＜０．０５）。结论　ＬＡＳＩＫ术后再次手术时应用飞秒激光再次制瓣后行波前像差引导ＬＡＳＩＫ可显著降低高阶像差，改善眩光、暗视力差和夜间驾车困难等。

Comparative study between femtosecond laser flap and opening original flap in retreatment of after-LASIK myopia

Objective To investigate the feasibility and clinical effects of retreatment on after-LASIK myopia with femtosecond LASIK. Methods Forty-three patients ( 86 eyes) with after-LASIK myopia in our hospital were chosen and divided into the observation group and control group according to the surgical methods. Twenty-five patients(50 eyes) in the observation group underwent wavefront-guided femtosecond LASIK for after-LASIK myopia,and 18 patients (36 eyes) in the control group were received opening-flap LASIK. At postoperative 6 months,the uncorrected visual acuity ( UCVA) ,diopter,lugh order aberration ( HOA) and contrast sensitivity function ( CSF) were compared. Results Postoperative patients in observation group had lighter corneal reactions and higher satisfaction; While in the control group,the majority of patients had different degrees of discomfort and incidence of epithelial ingrowth. UCVA at postoperative 6 months in observation group ( 1. 05 +0. 01) was higher than that of control group ( 0. 92 +0. 21) ,and the difference was statistically significant ( P < 0. 05 ) . The difference in diopter between observation group (0. 53 + 0. 34) D and control group ( - 0. 23 +0. 47 ) D was statistically sigruficant ( P < 0. 01 ) . Postoperative HOA,coma and spherical aberration in observation group were obviously decreased ( all P < 0. 05 ) ,while control group increased,and the difference was statistically significant between two group ( all P < 0. 05 ) . Postoperative HOA,coma and spherical aberration in observation group were lower than control group,and the difference was statistically significant ( all P < 0. 05 ). There was no sigruficantly difference between two groups in the trefoil aberration ( P > 0. 05 ). CSF in observation group was improved at five spatial frequency ( 1. 5 c . d -1 ,3. 0 c . d -1 ,6. 0 c . d -1 ,12. 0 c . d -1 ,18. 0 c . d’l ) ,and the difference was statistically significant ( all P < 0. 05 ) ; While postoperative CSF in control group was lower than preoperative at four spatial frequency ( 1. 5 c . d-l ,3. 0 c . d’I ,6. 0 c . d’l ,12. 0 c . d’l ,18. 0 c . d’I ) ( P < 0. 05 ) . There was no sigruficant difference between two groups in CSF at 6. 0 c . d’l ( P > 0. 05 ). CSF were sigruficantly better in observation group at five spatial frequency than control group ( all P < 0. 05). Patients satisfactory degree in observation group (92. 0% ) was higher than control group (77. 8% ) ( P < 0. 05 ). Conclusion Retreatment on after-LASIK myopia with wavefront-guided femtosecond LASIK can obviously reduce the high order aberration and correct glare,poor dark visual acuity and failure in driving at night.